Differences in Physical Performance Measures Among Patients With Unilateral Lower-Limb Amputations Classified as Functional Level K3 Versus K4.
Jaclyn Megan Sions, Emma Haldane Beisheim, Tara Jo Manal and 3 others
PMID 29410114WHAT IT FOUND
In community-dwelling adults with a unilateral lower-limb amputation, performance tests separated K3 from K4 in this sample.
K3 walked slower, took longer on Timed Up and Go, scored lower on AMPPRO, and walked less on six-minute walk. Self-report mobility did not separate them.
Key findings
01After controlling for age, BMI, time since amputation, and cause, self-reported mobility did not differ significantly, while performance tests showed significant differences between K3 and K4.
02K3 participants walked slower than K4 participants at both self-selected and fast 10-meter walk speeds.
03K3 participants had lower AMPPRO scores (40.4 points) than K4 participants (44.9 points).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study used a single amputee clinic and a clinical dataset, so the sample was limited to patients who completed all measures. Clinicians who assigned K-level were not blinded to the outcome measures, which may make the tests look better at separating K3 and K4 than they are in practice. The sample was mostly male and mostly transtibial amputation, so results may not apply to all people with lower-limb amputation. Generalizability is limited to community-dwelling, longer-term prosthesis users with unilateral transfemoral or transtibial amputation. BMI was calculated from weight with the prosthesis and without accounting for amputation level. The self-report questionnaires may have ceiling effects in higher-functioning adults, so they may not capture small differences. The study did not stratify by other covariates that may affect functional mobility.
Declared interests
One author is a consultant for Independence Prosthetics-Orthotics, Inc.
The easy way to misread this
Do not read the non-overlapping 95% CIs as evidence that these tests alone can assign K-level. K-level was assigned by clinicians who were not blinded to the outcome measures, and the study design may overestimate how well the tests separate K3 from K4.